Accuracy of point-of-care testing for hemoglobin measurement in children in resource-limited settings: a systematic review

Introduction. Anemia remains a significant global health challenge, particularly among children in resource-limited settings, with substantial impacts on morbidity, mortality, and socioeconomic development. Point-of-care testing (POCT) devices for hemoglobin (Hb) measurement offer a promising alternative to automated hematology analyzers in resource-limited settings, but their diagnostic accuracy and implementation challenges require systematic evaluation. Material and method. This systematic review adhered to PRISMA 2020 guidelines, analyzing studies published between 2020-2025 that evaluated POCT devices for Hb measurement in children (0-18 years) in resource-limited settings. Five studies met inclusion criteria, assessing four POCT devices (HemoCue Hb301, Aptus, Sahli’s hemoglobinometer, and Masimo Rad-67). Data on sensitivity, specificity, measurement differences (bias), and the range of variation in those differences (Limits of Agreement, LOA) were extracted, and quality assessment was performed using Joanna Briggs Institute (JBI) tools. Results. Of 483 records screened, only five studies met inclusion criteria, encompassing four POCT devices. Due to substantial heterogeneity in design and outcome reporting, a meta-analysis could not be performed. POCT devices demonstrated variable diagnostic accuracy: sensitivity ranged from 24.4% to 100%, and specificity from 70% to 100%. The HemoCue Hb301 was the most widely used device (80% of studies) but showed inconsistent performance, with mean bias ranging from −0.27 to 2.5 g/dL and wide LOA (−3.68 to 5.2 g/dL). Non-invasive devices like the Masimo Rad-67 had lower sensitivity (24.4–95.5%) and high specificity (89.1–96.7%). Key challenges included over/underestimation of Hb levels, environmental sensitivity (temperature, altitude), high costs, and the need for trained personnel. Conclusion. While POCT devices provide rapid, portable solutions for anemia screening in resource-limited settings, their accuracy varies significantly, potentially leading to misclassification. Standardized protocols, improved device robustness, and cost-effective innovations are urgently needed to enhance reliability. Future research should prioritize validation studies and meta-analyses to guide optimal POCT implementation in pediatric populations.